Facebook has made me acutely aware of my biological clock. Seriously. Call me naïve but I never really considered the fact that my prime reproductive years are in full swing until I began being bombarded by status updates: engagements, marriages, babies, marriages, engagements, and of course babies.
Suddenly I can’t help but wonder if I’ve had my thinking all wrong. I’ve always assumed that I have plenty of time to surpass the career goals I’ve set for myself, and have a fantastic family. But a friend recently told me that rather than risk not being an amazing mother due to splitting her time, she’s decided to forgo having children and focus on her career. My generation is definitely not the first to consider this question, to decide on what sacrifices we are willing or not willing to make. However, we have options that many women before us did not.
What does it mean to “freeze your eggs”?
Formally known as “oocyte cryopreservation” (OC), freezing eggs is the process of extracting a woman’s eggs, then freezing them to below zero temperatures to pause biologic activity. Later, the eggs are thawed, biologic activity resumes, and the eggs are fertilized and implanted into a woman’s uterus. From 1986 to 2008, 936 babies have been born from OC with rates of birth defects similar to rates seen in babies born from natural conception.
Previously, the American Society for Reproductive Medicine (ASRM) deemed OC an “experimental” procedure. As such, the ASRM recommended that OC only be available in Institutional Review Board approved clinical trials. However, several fertility clinics offered the service outside of these guidelines. Typically, OC has been utilized by:
- Women undergoing cancer treatment or afflicted with other medical conditions that affect fertility. Both chemotherapy and radiation for cancer treatment have been shown to cause temporary or permanent damage to the ovaries and uterus. Other medical conditions including genetic mutations that predispose women to ovarian cancer or ovarian failure, might require the removal of the ovaries. As a result, some women utilize OC to give them the option of having children after treatment.
- Those using in vitro fertilization (the process in which a sperm fertilizes an egg outside of the body). Couples undergoing in vitro fertilization (IVF) often face many difficulties including not being able to obtain sperm, or being unable or unwilling to freeze embryos for IVF. In these scenarios, OC can be an effective alternative.
- Women who want to preserve their fertility. As women get older, the number of eggs they have and the quality of those eggs both decrease. Therefore, some women choose OC to preserve their ability to have biological children.
Lifting the Experimental Label
On Monday (10/22/12), the ASRM released a report entitled: Mature oocyte preservation: a guideline, in which they assert that OC should no longer be considered an experimental procedure. OC was experimental due minimal data on the health of eggs after fertilization and the health of children after birth. One of the main complications of OC is that the human egg is a (relatively) very large, very fragile cell filled with water.The process of freezing and thawing the egg often resulted in the formation of ice inside the egg, which damaged its ability to function properly. This presented uncertainties as to whether the process would result in long-term defects or abnormalities in children born from frozen eggs.
In recent years, improvements in methods of freezing and thawing have improved the success of the eggs. After reviewing over 100 published articles on the safety and effectiveness of OC, the ASRM asserted that the evidence “demonstrate[d] acceptable success rates in young highly selected populations.”
The ASRM recommended OC for women experiencing medical treatment and/or conditions that might affect fertility, and for couples in need of eggs for IVF. However, ASRM cautioned against women electively choosing to freeze their eggs in an attempt to preserve fertility stating that “Marketing this technology for the purpose of deferring childbearing may give women false hope and encourage women to delay childbearing.” Furthermore, ASRM asserted the need for additional research, including studies that evaluate long-term effects on children born from frozen eggs, before they endorse common use.
To freeze or not to freeze?
Most significantly, this announcement provides more options for women and couples concerned with fertility. It’s important to understand the process, including its risks and benefits, but it’s also important to consider the ethical implications of such progress.
The advances that modern medicine has made in reproductive technology understandably makes some people uneasy. Just because we can do it, does that mean we should? Personally, when considering the large strides many people take to have biological children, I can’t help but consider the millions of children in need of adoption, what about them? On the other hand, with the technology available, why shouldn’t individuals be afforded the opportunity to have children that share their biological makeup? And if ideals about our futures don’t work out the way we’ve planned, why shouldn’t women who want to have a family be allowed this option for reproduction?
All big questions to consider but in the mean time, I think I’m safe to ignore the exasperating tick tock of my biological clock awhile longer…no matter what Facebook tells me.